Vol. 11, No. 5
Welcome to the August edition of Tips and Topics.
David Mee-Lee M.D.
I am not a golfer. Mini golf is fun – it fits my level of expertise. Ping-pong (table tennis) is even more fun. This month’s SAVVY is about golf, a bit strange since I am not all that into it. As usual, I listen to National Public Radio’s Science Friday. You can hear the July 26, 2013 program yourself. http://www.sciencefriday.com/segment/07/26/2013/phil-mickelson-takes-a-swing-at-science.html
Before you do listen, let me tell you some points that struck me.
Structured, focused deliberate practice is more important and effective than many hours of general, non-specific activity.
Phil Mickelson beautifully described examples of deliberate practice that has made him such a winner. In SKILLS, I’ll tie this together – to make sense of this for our work in addiction and mental health.
A few of Dr. Smith’s points:
- Deliberate practice is structured practice with a specific focus on objectives and outcomes.
- Before hitting a ball, the part of the brain that activates in amateurs is the limbic area, which is associated with emotions. However for the professional, the part of the brain which “lights up” is the pre-supplementary motor cortex; this is “associated with the generation of movements; and the sequence and planning of movements.”
- In other words, an amateur’s emotions of any uncertainty, anxiety and worry- even before taking the shot- will affect the effectiveness and outcome of the shot. By contrast, the more effective golfer’s brain is activated around the actual motor activity of how to hit the ball, where it will land and how to apply the exact force needed to get as close to the flag and the hole as possible.
Now for how Phil Mickelson explained what he does, which fits right into deliberate practice:
- Phil explained he uses science as well. He knows: If I am within 3 feet of the hole, I have a 100% chance of sinking the putt (putting the golf ball in the hole). Four feet out, that drops to 88%; 5 feet drops further to 75% ; and 6 feet, he has a 67% chance of success.
- Therefore, Phil practices to land the ball within that 3 feet circle. Then he knows he’ll sink the putt.
- Similarly, he practices to know what a 145 yard drive feels like -what kind of force, angle, stance etc.he needs to apply to make the ball go 145 yards…or go 115 yards. So when he is in a tournament and knows he has to make 118 yards, he knows exactly what 115 yards feels like. He can then add a touch more to reach 118 yards and put the ball in that 3 feet circle.
- What is he talking about? Focused practice and practice with a purpose…and it doesn’t have to be for hours on end. 45 to 50 minutes of focused practice or even 15 or 20 minutes is more effective than hours of random hitting of golfballs on the practice range.
- So Phil’s practice involves: getting the ball to that 145 yard mark or within the 3 feet circle of the hole – focused practice with a purpose, not random, unplanned general activity.
Practice without real-time feedback is like hitting golf balls and not tracking where they land.
A related lesson from a golfer a bit closer to the behavioral health field…..
This comes from a keynote presentation at the 2013 Annual Conference of the California Association of Marriage and Family Therapists (CAMFT). Jim Walt is a licensed Marriage and Family Therapist and an ICCE Associate (International Center for Clinical Excellence, http://www.centerforclinicalexcellence.com). Scott D. Miller, Ph.D., my colleague and friend, has influenced my thinking about treatment outcomes, real-time feedback, the therapeutic alliance and more recently, deliberate practice.
In the Top PerformanceBlog section on his website, www.scottdmiller.com, you can watch Jim Walt talk about golf and what it has to do with Feedback-Informed Treatment (FIT). Just like Phil Mickelson was saying: If your practice is not focused with purpose, you may feel like you are doing good work, but without feedback, you don’t really know if you are being effective.
- When you drive the golf ball, you need immediate feedback on how close you came to the 3 feet circle of the hole; or how far away you were from the 145 yard mark.
- Based on that real-time feedback, you can know whether you have to apply more force, a better angle or adjust your grip on the golf club to hit your mark.
- Hitting golf balls with no feedback is meaningless practice if the goal is to be effective and purposeful.
- Jim Walt talks about how we should relish getting feedback from the client on whether the just-completed session with him hit the mark – or not. Even better,candid feedback on how the session was not helpful provides the information the therapist needs to know how to adjust things for the next session.
Take a look at Jim’s golf lesson:
Now let’s try to pull this together for your daily work.
Deliberate practice has been around for a while, but relatively new to me and maybe you too. You can see a nice summary at http://expertenough.com/1423/deliberate-practice
Find the edges of your comfort zone and practice those specific skills.
Just as Phil Mickelson knows what specific target he needs to reach (a 145 yard drive; or to putt from within a 3 feet circle of hole), find the edge in a clinical skill you have to practice to reach. That is your target for practicing.
Take the task of engaging a client quickly and completing an assessment in one hour.
What are the edges of your comfort zone?
- Finding a quick way to make your client comfortable?
- Asking questions quickly and comprehensively?
- Doing this all under time pressure, but in a friendly manner?
When practicing for the oral part of my Psychiatry Board-Certification examination, I knew I would only have 30 minutes to interview a patient, formulate my provisional diagnosis and be ready to discuss the case with two examiners. For weeks before, I practiced how to ask assessment questions in ways that didn’t take a lot of words, but was still comprehensive enough to obtain the needed information.
Instead of asking: “Now tell me about your sleep pattern. Do you have trouble falling asleep or do you get to sleep and then find yourself waking up in the middle of the night?” That may seem reasonably efficient, but not as streamlined as: “Do you have troublegetting to sleep or staying asleep or both?”
Dr. Smith, the sports scientist, found that amateur golfers’ limbic system (associated with emotions) lit up with performance anxiety and uncertainty. This negatively affected the accuracy of their golf shot. On the other hand, the professionals had a focused, purposeful practice. This allowed their limbic systems to stay quiet, and let their skills shine forth, free of any emotional baggage.
Back to the task of engaging and assessing quickly:
If you’ve practiced and built your confidence and competence, now you can channel your energy into the task at hand, instead of wasting it on performance anxiety.
Help clients practice to know what it feels like to be relaxed or serene.
Not only does Phil Mickelson know his specific target, he understands what it feels like to hit that target. By deliberate practice to reliably and repeatedly hit his target, his body, posture, muscle exertion and force of the stroke all feel a certain way that he can reliably replicate- over and over again.
Take the client who is struggling with anxiety. Because anxious feelings are mutually exclusive of feelings of relaxation, the goal is to have them know what it feels like to be relaxed, as much as they know what it feels like to be anxious.
If you simply tell your client to “just relax”, they do not know what relaxation feels like- UNLESS they practice! This is where the technique of progressive relaxation comes in.
When anxiety next arises, the client can call up feelings of relaxation to replace the anxiety.
Not all sensations need to be practiced to know what they feel like.
- If I cut a very sour lemon in half, and squeeze the juicy lemon into your mouth, can you immediately call up what that feels like? Maybe your salivary glands are already working just by imagining the lemon in your mouth?
- Or -imagine my fingernail poised on the chalkboard. I am about to run my fingernail squeaking over the surface. Can you already feel your skin crawl and your ears twinge, anticipating that awful scratching, scraping sound! No need to practice what that feels like, it is almost in your DNA.
In the midst of an anxiety attack, a client who has practiced relaxation a hundred times before can quickly evoke a relaxed state. They know what it feels like now.
Be excited when clients tell you if the session didn’t help.
If a client has a safe and trusting enough relationship with you, and you’ve created a culture of feedback, they can authentically tell you that you didn’t help them at the end of the session. Or if you invite their comment about what works for them, and the model/methods you’re using, they may tell you “It’s not working.” This is great news! It gets you closer to your mark of a successful outcome. It helps when clients can tell you you messed up, or didn’t listen to them, or you’re on the wrong track.
Better to know you’re missing the mark (than to think you’re putt-ing within the 3 feet circle of the hole, when you are actually 4 feet away.) Or to know you are nowhere close to 115 yards. This way you can adjust your methods to hone your skill and reach the desired goal.
So real-time client feedback provides the information you need to improve your craft, practice better engagement, to listen better, to facilitate client change and improve outcomes.
This month I had a birthday. No need to send wishes or gifts……I’m not fishing for those. It is interesting how many companies remember my birthday almost better than I, or my loved ones, do.
Companies send you all kinds of wishes and even real loot. Starbucks gives you a birthday drink – any size or price you want. If I want, I could have the big Trente (31 oz size) not simply the economical 8 oz size. It’s my birthday and the store is mine!
Here’s what CVS Pharmacy sent me. AND check the fine print*:
Happy Birthday – Save $3 on any purchase*
Just for you for your birthday!
One time only
Coupon redeemable in store only.
*Maximum $3 value. Valid in-store only. ExtraCare card must be presented to receive the offers. Excludes alcohol, gift cards, lottery, money orders, prescriptions, postage stamps, pre-paid cards, and tobacco products. Not valid at MinuteClinic®. Tax charges on pre-coupon price where required. Limit one coupon per customer. No cash back.
CVS/pharmacy will not accept offers printed from unauthorized internet postings or reproductions, copies, or facsimiles of this offer. This coupon is the copyrighted property of CVS/pharmacy; it is intended for use by ExtraCare cardholders who subscribe to the CVS/pharmacy email program and have received this message directly from CVS/pharmacy. CVS/pharmacy reserves the right to reject any coupon presented by parties outside of the original distribution list. Original coupon must be relinquished at the time of purchase. Coupon is void if copied, transferred and where prohibited by law.
Please note: All images may not print in your internet browser. Just print the coupon in black and white or color, and bring it to the store as-is.
That fine print is like those TV adds for the miracle depression pill; it takes 10 seconds to describe the medication and 30 seconds to warn you of precautions and side effects. The gift sounds like a gift -until you read the fine print.
Now here’s my point. My birthday will forever have mixed feelings, like these gifts with the fine print. Because my father died at age 72 in 1976 ….on my birthday! And just last year, my mother at 97 years of age died….on my birthday too!
So this is a one-year anniversary and birthday – with very mixed feelings. I have made meaning and comfort of this however, by seeing their death as the birth of carrying forward their legacy of service to others, which they exemplified in their lives.
My birthday will always have the fine print.
Until next time
I’m glad you could join us this month. See you again in late September.